Northwestern Michigan Emergency Physicians PC
Organization Active NPI Emergency Medicine Physician · Traverse City, MI
NPI 1073597944 · NPPES record last updated Oct 10, 2023
Key facts
- NPI
- 1073597944
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 3 (MI)
- Legal business name
- NORTHWESTERN MICHIGAN EMERGENCY PHYSICIANS PC
- Practice address
- 1105 6TH St
Traverse City, MI 49684-2349 - Phone
- (231) 218-1310
- Fax
- (801) 740-2847
- NPI assigned
- Dec 2, 2005
- Organization subpart
- No
Authorized official
- Name
- Ms. Yvonne E Kaehler
- Title
- Adminstrator
- Phone
- (231) 218-1310
Practitioners 95
-
Sally Ann Ancel, D.O.
-
Matthew A Bowes, MD
-
Melodie R Brown, M.D.
-
Jill Anne Burden, D.O.
-
Megan Lucille Burroughs, D.O.
-
William B Chung, M.D.
-
Michaela Coffia, NP
-
Brigid Deleo, FNP-C
-
Richard G Faller, M.D.
-
Jon S Foltz, MD
-
Lucinda Geiser, NP
-
Mark Travis Hemming, M.D.
-
Shannon Marie Hicks, FNP-C
-
Julie K Johnson, D.O.
-
Marc S Krakow, M.D.
-
Tamella Paige Livengood, MSN, FNP
-
Daniel M Mann, M.D.
-
Ryan P McConnell, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061019000359 | MI | Part B Supplier - Clinic/Group Practice | 7214933928 |
Receives reassigned benefits from 81 practitioners Practice locations: Charlevoix, MI; Gaylord, MI; Traverse City, MI |
National Provider Directory
Locations
10850 E Traverse Hwy
Ste 1175
Traverse City, MI 49684
Phone (231) 935-0497
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | 3 | MI | Yes |
Addresses
Primary practice location
1105 6TH St
Traverse City, MI 49684-2349
Mailing address
PO Box 72231
Cleveland, OH 44192-0002
Phone (231) 218-1310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010B860320 | Other | MI | BCBS |
| CA0617 | Other | MI | RAILROAD MEDICARE GROUP |
NPI Registry JSON
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1696896000000",
"number": "1073597944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 72231",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441920002",
"telephone_number": "231-218-1310",
"fax_number": "801-740-2847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 6TH ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842349",
"telephone_number": "231-218-1310",
"fax_number": "801-740-2847"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHWESTERN MICHIGAN EMERGENCY PHYSICIANS PC",
"organizational_subpart": "NO",
"enumeration_date": "2005-12-02",
"last_updated": "2023-10-10",
"certification_date": "2023-10-10",
"status": "A",
"authorized_official_last_name": "KAEHLER",
"authorized_official_first_name": "YVONNE",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "ADMINSTRATOR",
"authorized_official_telephone_number": "231-218-1310",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": "MI",
"license": "3",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "010B860320",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GROUP",
"identifier": "CA0617",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
- Northwest Michigan Surgical Group, P.C.
- Northwest Senior Resources Incorporated
- Northwestern Michigan College
- Northwestern Michigan Dermatology
- Northwestern Michigan Dermatology PC
- Northwestern Michigan Neonatology
- Northwood Cosmetic Dental Group, PC
- Northwood Obstetrics and Gynecology,PC
- Niklas Norton
- Mark D Noss
All providers in Traverse City, MI · Emergency Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.